What is surgical aortic valve replacement?

Surgical aortic valve replacement (SAVR) is an open-heart procedure to replace a diseased aortic valve. You may get a biological valve made from animal tissue or a mechanical valve made from carbon, steel, or synthetics.

At Mass General Brigham Heart and Vascular, we offer advanced treatments for common to complex heart valve problems. Our Heart Valve Disease Treatment Program and Aortic Disease Treatment Program are one of the largest, most experienced in the nation with success rates above national and regional averages.

Who needs aortic valve replacement surgery?

Your healthcare provider may recommend aortic valve replacement if you have severe aortic heart valve disease. The aortic valve controls blood flow from the heart’s left ventricle to the aorta (the body’s largest artery).

Aortic valve replacement treats:

• Aortic valve regurgitation: The aortic valve doesn’t close properly, allowing blood to flow backward into the left ventricle as your heart is relaxing. Aortic valve regurgitation causes chest pain, heart palpitations, fatigue, and other symptoms. Left untreated, it may lead to heart failure.
  
  
• Aortic stenosis: The aortic valve opening narrows and restricts blood flow from your heart to the aorta. The heart must then work harder to pump blood to the body. Aortic valve stenosis increases your risk of heart failure and sudden cardiac arrest.

Your care team may recommend an alternative to SAVR, such as transcatheter aortic valve replacement (TAVR) or the Ross procedure, depending on your age, anatomy, and overall health.

Benefits of aortic valve replacement surgery

A new aortic valve treats aortic valve regurgitation and aortic valve stenosis. By improving circulation, SAVR can lower your risk of heart failure and sudden cardiac arrest. It also improves your quality of life by easing chest pain, shortness of breath, and extreme fatigue. You should have more energy to enjoy the activities you love.

Risks of aortic valve replacement surgery

Heart surgery is complex and carries a risk of complications. Our team of highly skilled cardiac surgeons performs more than 3,000 heart surgeries every year. This high volume, combined with our decades of experience, means a lower chance of complications and higher success rates.

Potential risks of SAVR include:

• Bleeding, blood clots, and stroke
• Heart attack
• Heart rhythm changes (cardiac arrhythmia)
• Infection

How to prepare for aortic valve replacement surgery

In the weeks before surgery, we’ll discuss the procedure, answer your questions, and help you understand what to expect. Your care team carefully guides you through preparation, which is critical to successful surgery. You’ll have several tests before the procedure, such as:

• Blood tests
• Coronary angiogram
• CT or MRI
• Duplex ultrasound
• Echocardiogram
• Electrocardiogram (ECG or EKG)

Your care team will tell you when to stop taking certain medications before surgery and when to stop eating and drinking the day before surgery.

What to expect during aortic valve replacement surgery

You’ll have general anesthesia and sleep through the procedure. A team of specialists will monitor your oxygen levels, blood flow, blood pressure, and other vital signs during surgery.

Here’s what happens during surgical aortic valve replacement:

1. Accessing the heart: The surgeon accesses your heart through an incision in the chest. This is most often done through a sternotomy (opening the breastbone), but minimally invasive approaches may be possible in some cases.
2. Connecting to a heart-lung machine: Places you on a cardiopulmonary bypass machine (heart-lung machine) to keep blood and oxygen circulating.
3. Stopping the heart: The heart is temporarily stopped so the surgeon can work safely. This procedure cannot be done on a beating heart.
4. Removing the damaged valve: The surgeon removes the diseased or malfunctioning aortic valve.
5. Sewing in the new valve: A new valve—either mechanical or tissue—is sewn into place.
6. Restarting the heart and coming off bypass: Once the new root and valve are in place, the heart is restarted and you are gradually weaned off the heart-lung machine.
7. Closing the incision: The surgeon closes the chest and incision with care to support healing.

Recovery after aortic valve replacement surgery

Most people stay in the hospital for four to six days, but everyone’s recovery is different. You'll rest in the cardiac intensive care unit before moving to a room in the cardiac step-down unit, where we closely monitor your progress. Your team provides pain relievers, blood thinners, and other medications as needed.

After discharge, you will see your care team for checkups and imaging tests to ensure the new valve works properly. Your care team may recommend participating in cardiac rehabilitation a month or so after surgery. This supervised program helps you safely return to activities and strengthens your heart.

It can take up to three months to fully recover from open-heart surgery. Your care team will provide instructions for caring for your incision and managing pain. They’ll also let you know when it’s safe to resume activities like driving.

If you have a mechanical aortic heart valve, you must take blood-thinning medications (anticoagulants) for life. These drugs lower the risk of blood clots that cause strokes. If you receive a biological (tissue) valve, you may not need lifelong blood thinners.

FAQs about surgical aortic valve replacement (SAVR)